Healthcare Provider Details

I. General information

NPI: 1932474574
Provider Name (Legal Business Name): CANFIELD PHARMACY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E MAIN ST
CANFIELD OH
44406-1318
US

IV. Provider business mailing address

11 E MAIN ST
CANFIELD OH
44406-1318
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0226
  • Fax: 330-286-0269
Mailing address:
  • Phone: 330-286-0226
  • Fax: 330-286-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022186850
License Number StateOH

VIII. Authorized Official

Name: DAN WEARSCH
Title or Position: MEMBER,PIC,AO
Credential: RPH
Phone: 330-286-0226